DS: GI and Intraabdominal Infection Flashcards

1
Q

Framework of IDSA Intraabdominal IAI guidelines

A
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2
Q

Defining types of intra abdominal infection

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3
Q

Health-care associated

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Presence of any risk factors:
- invasive device at time of admission
- Hx of MRSA infection or colonization
- Hx of surgery
- Hospitalization
- Dialysis
- Residence in long term care facility in last 12 month

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4
Q

Hospital-onset

A

Positive culture >48 hours of hospital admission

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5
Q

Uncomplicated IAI

A

Affects a single organ only without spread into the peritoneum

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6
Q

Complicated IAI

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Extension beyond hollow viscus of origin into peritoneal space → peritonitis or abscess formation

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7
Q

IAI Specific Pathogens

A

Note: the further you go down the bugs change and the amount of bug changes

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8
Q

Organ infection:

A

Appendix: Appendicitis
Gall bladder: cholecystitis
Bide duct: cholangitis
Pancreas: pancreatitis
Colon: Diverticulitis

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9
Q

Treatment of high risk - Community-acquired complicated appendicitis

A
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10
Q

Patient Management

A

Fluid/cultures not routinely approved for patient with community acquired infection unless clinicaly toxic or high risk

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11
Q

Duration IAI: STOP IT TRIAL

A

Control group: 8 days; Experimental group: 4 days
Patient population is adult with complicated intra abdominal and adequate source control
Endpoint: surgical site infection, recurrent infection or death within 30 days after source control
Bottom line: Complicated IAI can be treated with 4 days of abx if adequate source control
Post hoc analyses:
Polymicrobial infection do not have worsen outcome than monomicrobial
Inclusion of vancomycin as part of broad spectrum coverage does not improve outcomes in IAI

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12
Q

Management of appendicitis with abx only

A

Appendicitis cannot be treated by just abx
Two recent non-inferiority studies demonstrated that abx alone are inferior to surgery plus abx for acute appendicitis
2020 Update: CODA study: 1552 adults with appendicitis. Abx were non-inferior to laparoscopy appendectomy –> but still fairly new information

for test questions - it’s always no

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13
Q

Healthcare-associated complicated IAI - Empiric treatment

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14
Q

Other pathogens: Enterococcus

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15
Q

Other pathogen: Candida

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16
Q

Other pathogen: MRSA

A
17
Q

New drugs for IAI: Avycaz and Zerbaxa

A

No activity against enterococcus
No activity against anaerobes
KPC: Ceftolazane/Tazobactam is not active against CRE with KPC beta-lactamase (most common CRE in the USA)
Both of these medications are FDA approved for IAIs

18
Q

New Drugs: Eravacycline

A

Evaracycline
-Broad spectrum activity (GN, GP, anaerobes) - including CRE and ESBL
-No PsA coverage
-Better tolerability than tigecycline (less nausea and diarrhea)
-FDA indicated for complicated IAI

NOTE: omadacycline not indicated for IAI (good test question)

19
Q

New Drugs: Relebactam

A

Relabactam:

Class A/C beta-lactamase inhibitor

Used in imipenem-cilastin

Restores activity vs. CRE (Klebsiella) and PsA

FDA approved for cIAI: Tested the addition of relebactam vs. placebo to imipenem-cilastin
Also approved for cUTI

20
Q

Pancreatitis Management

A
21
Q

SBP Diagnosis and Management

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22
Q

SBP Treatment

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23
Q

SBP ppx

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24
Q

Acute cholangitis

A

Definition: Biliary obstruction complicated by infection
Presentation: can be severe with jaundice and elevated transaminases
High mortality rates → early broad spectrum abx
Source control → usually ERCP directed internal drainage within 24 hours
Empiric tx: Broad spectrum (GPO and GNO including anaerobes); enterococcus coverage in patients with hepatic disease or severe immunocompromised patient

25
Q

IAI: Diverticulitis

A
26
Q

IAI: H. Pylori Treatment

A

All patients tested for positive H. pylori should be treated
- increased risk for gastric cancer if untreated
- All patients with peptic ulcer disease should be tested for H.pylori
- All consider testing in patients taking low-dose aspirin or chronic non steroidal anti-inflammatory therapy to reduce the risk of GI bleed

27
Q

Persistent H.Pylori Treatment

A
28
Q

IAI: Infectious diarrhea Risk factor

A

Risk factors: travel to developing countries, close contact with infected person, poor sanitation

29
Q

Infectious diarrhea Etiology

A

May be food bourne or waterborne
International travel
Use of abx agents
Immunocompromised host
Exposure to infected/colonized animals
Attendance at childcare facilities
Residence in long term care facilities
Hospitalization
Certain sexual practices

30
Q

Infectious diarrhea approved abx by pathogen

A
31
Q

Antiparasitic Therapy by pathogen

A
32
Q

Specific dosing for infectious diarrhea

A
33
Q

Specific dosing for infectious diarrhea - cont…

A
34
Q

Shiga Toxin - Producing E.coli

A

Shiga Toxin-producing E.coli (STEC): Blood Diarrhea:

Leading cause of hemolytic uremic syndrome in children and adults

Hemolytic uremic syndrome (HUS): hemolytic anemia, thrombocytopenia, AKI

DONT” TREAT WITH ABX

35
Q

CDI - Laboratory testing for CDI

A

GDH (glutamate dehydrogenase) is common antigen of C.difficiles that can detect either the toxigenic or non toxigenic form

If positive - should be followed by the PCR test (stool toxine B NAAT)

Important to do GDH test and add on stool EIA toxin test
Do not perform repeat testing within 7 days during the same episode of diarrhea
Do not screen asymptomatic C.difficiles carriage at admission

36
Q

Updated Initial treatment for CDI

A
37
Q

Recurrent treatment for CDI

A
38
Q

CDI important note

A

Important:
Do not perform repeat testing within 7 days during the same episode of diarrhea
Do not screen for asymptomatic C.difficile carriage at admission
No recommendation on probiotic or PPI use
Discontinue inciting abx if possible

39
Q
A